Clinica Terapeutica最新文献

{"title":"Legal Considerations in Bioidentical Hormone Replacement Therapy: Anticipating Future Challenges in Medical Liability.","authors":"F Del Duca, G Santangelo, G Bogani, V Di Donato, G Perniola, F Spadazzi, A Ghamlouch, A Maiese, P Frati, C Trignano","doi":"10.7417/CT.2025.5184","DOIUrl":"https://doi.org/10.7417/CT.2025.5184","url":null,"abstract":"<p><strong>Abstract: </strong>New pharmaceutical formulations containing multiple active pharmaceutical ingredients have entered the market, combined to form compounded Bioidentical Hormone Replacement Therapy (cBHRT). The rise of alternative therapies is due to a large amount of misinformation about hormone replacement therapy and unexplained fears among the female population. This commentary reviews the impact of cBHRT on the current post-menopausal syndrome. Compounded Bioidentical Hormone Replacement Therapies are formulations of well-known active pharmaceutical ingredients (APIs) derived from plants. In fact, users report that these products seem to be safer and more effective than FDA-approved hormonal replacement therapy. A literature research was performed to address common questions posed by physicians and patients with climacteric syndrome about cBHRT. This study raises several questions about cBHRT. First of all, no safety and security studies of individual cBHRT formulations have been performed. The efficacy of a cBHRT formulation based on personalized treatment appears to be ineffective. The costs of individual galenic preparations do not justify the efficacy and risks of cBHRT. On the medico-legal issue, galenic preparations have two types of possible risks: generic and specific. A generic risk is connected to the preparation, operator-dependent errors, and hygienic precautions. The specific risk of collateral effects is the possible drug-to-drug interactions, which have not been studied yet. The lack of scientific information exposes the prescribing physician to accusations of improper prescription and possible preventable risks. Caution in the prescription of cBHRT is always warranted.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"36-39"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The usability of umbilical cord blood and infant blood procalcitonin as an early diagnostic marker in diagnosing early onset bacterial sepsis to enhance antibiotic stewardship (A prospective, case-control study).","authors":"F G Yehia, H Elhakeem, E E Mohamed, L A Gad, N R Hussein, A A A Ali, M I M Attalah, E H F Abouzied, A H Mostafa, E I Sorour, A Y Abdelgawad, A M A Mahmoud, A S I Mansour, A I M Hasan, M M M Saber, M M El Naghi, A A A Hamed, M F I Mosa, A F A Mohammad, M A Khoudary, A M M Omar, M A S Abd Elghaffar, A M I Gaafar, M A H Ahamed, A H I Ahmed, A A M El-Samman","doi":"10.7417/CT.2025.5203","DOIUrl":"10.7417/CT.2025.5203","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate if umbilical cord blood and infant blood procalcitonin could be useful to distinguish infected from healthy newborns with or without early onset bacterial sepsis (EOS) risk factors.</p><p><strong>Patients and methods: </strong>This prospective case control study was done at Al-Azhar University Hospitals pediatric and neonatology departments (Alhussain, Alzahraa & Assiut branches), Helwan and Luxor University Hospitals during a period started from January 2023 to July 2023. Proclcitonin (PCT) was examined in umbilical cord blood from neonates that were 32 weeks or older at birth and after 24 hours after birth (Del PCT). Groups had the following definitions among the subjects: 1) EOS that was confirmed by culture; (n=20) 2) EOS that might occur based on risk factors for which antibiotics were given for less than 72 hours; (n =20) 3) risk factor(s) for EOS that could occur with no given antibiotic therapy; (n=20) 4) Healthy controls (n = 100). In addition, if taking blood was required for routine treatment, tests for C-reactive protein (CRP) and PCT were performed on venous or capillary blood.</p><p><strong>Results: </strong>Umbilical cord blood PCT levels were significantly higher in samples of group 1 compared to other groups. The cut-off of the umbilical cord CRP was 10.5 mg/L, the sensitivity, specificity, PPV and NPV were 41, 88.0, 29 and 28%, respectively. At a PCT cut-off of 1.18 ng/mL, the sensitivity, specificity, PPV and NPV were 79, 91, 51 and 61%, respectively.</p><p><strong>Conclusion: </strong>Neonates ≥32 weeks with a confirmed or probable EOS had higher umbilical cord blood PCT levels, but those with EOS risk factors have lower levels. However, PCT does not appear to be a good indicator following antibiotic therapy for the mother. So, to differentiate between healthy and infected neonates with or without EOS risk factors, PCT may be helpful.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"180-185"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The critical role of vaccinations for Healthcare Workers after COVID-19.","authors":"D Shaholli","doi":"10.7417/CT.2025.5199","DOIUrl":"10.7417/CT.2025.5199","url":null,"abstract":"<p><strong>Abstract: </strong>The COVID-19 pandemic underscored the importance of vaccinations in protecting both healthcare workers (HCWs) and their patients. With the retreat of the pandemic, attention must now shift to reinforcing routine immunizations among HCWs, including measles, varicella, rubella, and other vaccine-preventable diseases. This letter highlights the need for mandatory vaccinations for HCWs to minimize nosocomial infections and ensure patient safety, drawing insights from recent studies on vaccine coverage and attitudes in the healthcare sector.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"158-159"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tips and tricks of anorectal care with topical lidocaine (octose-dan) administration: retrospective, anecdotical, spontaneous, and observational study.","authors":"B Palmieri, M Vadalà","doi":"10.7417/CT.2025.5204","DOIUrl":"10.7417/CT.2025.5204","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The local symptomatic treatment of anorectal diseases encloses a wide variety of creams, ointments, suppositories, irrigation fluids etc, based essentially on anaesthetics, antioedema, phlebotomids, keratolytic and coating agents, anti-inflammatories, steroids, aiming at achieving fast improvement and at least partial pain remission especially soon after stool. Unfortunately, the method of blending different chemicals pooled in a single formulation often prevents the full curative effect of each active principle: in fact, the stechiometric balance of these melting pots does not achieve the full dose-effect of each one; furtherly the patients would be warned to use only effective evidence-based products, preventing the risk of skin and mucosa sen-sitization in the long run when different chemical or herbal compounds are together administered. On the basis of the literature review, we focused our study on a single drug-medication whose properties go beyond the classic anaesthetic claim: lidocaine 5%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;In our anecdotical, spontaneous, and observational study, 30 patients both sexes (15 males and 15 females), recruited from the Second Opinion Medical Consulting Network for a spontaneous anecdotical post marketing evaluation of grade 1,2,3 haemorrhoids (n=23), anal fistulas (n=2) and fissures (n=5) treatment with a 5% lidocaine ointment (Octosedan Laboratori Baldacci S.p.A., Italy) for two months; the primary endpoints of the investigation were tolerability and effectiveness to relieve pain, itching, soiling and discomfort at rest or during and after stool emission. The most commonly reported symptom was bleeding, present in 20 patients with prevalence in women. In 13 patients (43,33%) the \"wet anus\" with or without soiling was present, while 12 patients (40%) complained of intermittent itching. In 7 patients (23,33%) hemorrhoidal thrombosis with prevalent (6/ 7) heavy pain, was recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;28/30 treated patients had significantly symptom impro-vement (p&lt;0.0001), 10 (33,33%) patients were addressed to surgical therapy for persistence of symptoms, (7 at the end of the therapeutic cycle 3, spontaneously asking to anticipate surgery before the end of the trial) 4 clinical cases fairly improved but accepted a further surgical revaluation three months later. Of the 19 patients previously treated with flavonoids or heparinoid therapy with unsatisfactory results, 9 (30%) participants found benefit from the new treatment. Of the 5 patients whose anal fissures healed primarily, only 1 patient developed a recurrent fissure within 6 months. Octosedan administration relieved the pain after 5 days with a tolerable life quality and promoted fissures healing in one month. No adverse effects of the treatment were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The local symptomatic treatment of haemorrhoids grade one, two, three and of the fissures, and the fistul","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"186-194"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Maternal and Fetal Death by Idiopathic spontaneous intraperitoneal hemorrhage in a nulliparous Pregnant at the Second Trimester.","authors":"N Pascale, G Bertozzi, M Ferrara, M Treglia, M Calvano, A Di Fazio","doi":"10.7417/CT.2025.5182","DOIUrl":"https://doi.org/10.7417/CT.2025.5182","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous intraperitoneal hemorrhage is a rare and potentially fatal condition historically known as \"abdominal apoplexy\". It refers to the non-traumatic and non-iatrogenic rupture of one or more small splanchnic vessels causing massive abdominal bleeding. In general, hemoperitoneum can be associated with various causes, however, in other cases, known as spontaneous hemoperitoneum during pregnancy, the etiology remains unidentified.</p><p><strong>Case report: </strong>The case of a 33-year-old, otherwise healthy and with no traumatic history, primigravida-23-week pregnant is presented. It dealt with a suddenly developed shock status, during a dinner in a public place. At Emergency Service arrival, she was already dead. A judicial autopsy was decided, in suspect of a rescue delay. The full autopsy showed a massive hemoperitoneum, with no origin of hemorrhage; the histological examination confirmed the hypovolemic shock with hypoxic-ischemic suffering of the intestinal mucosa. In conclusion, the cause of death was attributed to a hypovolemic shock due to idiopathic spontaneous intraperitoneal hemorrhage. Any responsibility in Rescue Emergency was excluded.</p><p><strong>Discussion: </strong>In similar cases of unknown bleeding etiopathogenesis, the hypothesis is that the repeated distension of the vessels during pregnancy, together with defects or thinning of the vascular wall, predisposes to its rupture, causing bleeding with no identifiable origin, probably involving branch of the celiac axis. The present case suggests the need to consider the diagnostic suspicion of this condition when atypical and unrelated symptoms in pregnant women appeared. To the best of our knowledge not many cases reported as much ble-eding as in this case whereby the bleeding point was obscured. As a result of these assessments, the liability of healthcare professionals was excluded. Therefore, in all analogous cases the autopsy, clinical or judicial, is mandatory both for the analysis of the process as a tool for risk management, and for the economic evaluation from a medico-legal perspective.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedical care for maritime workers: health care liability issues related to possible regulatory decoupl.","authors":"G D'Antonio, G Bolino, S Del Prete, L Pellegrini, T Berloco, M Treglia, M Arcangeli","doi":"10.7417/CT.2025.5185","DOIUrl":"https://doi.org/10.7417/CT.2025.5185","url":null,"abstract":"<p><strong>Abstract: </strong>Telemedicine has now spread globally because of the many benefits it offers both to health care facilities and to people living in unfavorable conditions (the elderly, patients with reduced mobility, residents in remote areas, etc.). The COVID-19 pandemic has resulted in further impetus for telemedicine application development, to maximize available resources. However, this innovative type of physician/healthcare facility/patient relationship has opened up several questions in relation to various possible assumptions of professional liability. In fact, the medico-legal issues that can arise in scenarios involving equipment, professionals and patients that also belong to different nationalities and, therefore, subject to different regulatory systems are obvious: precisely the regulatory decoupling represents one of the thorniest and most debated issues at the international level on the subject of teleme-dicine. In the maritime sphere, this issue could be further amplified (e.g., telehealth for a patient from one nation, on ships under the flag of a different nationality, within the maritime boundaries of a third nation). In Italy, the use of telemedicine has its roots precisely in the maritime sector back in the early 20th century, when the International Center for Medical Radiocommunications (CIRM) was established. In 2002, CIRM was identified internationally as the Italian Center Responsible for Maritime Telemedical Assistance (TMAS), with the purpose of providing remote health care for passengers on any ship that required it, 24 hours a day, while also being able to suggest their transfer to land. Indeed, since TMAS is a national competence, should professional liability profiles occur, CIRM physicians would be liable under Italian law. Therefore, the example of CIRM as a referral center for telemedicine in the maritime sphere could be a model for reference in other contexts as well: in particular, the identification of telemedicine service delivery centers dependent on the National Health Services (NHS) could allow for the appropriate regulatory contextualization of telemedical malpractice cases, thereby resolving the medico-legal uncertainties that could hinder the dissemination as well as the proper application of telemedicine.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"40-43"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occurrence Of Long COVID In Healthcare Workers At A University Hospital And Challenges In Insurance And Compensation Evaluation.","authors":"C Giorgianni, V Cianci, C Pitrone, G Burrascano, C Mondello, N Gullì, P Gualniera, A Asmundo, D Sapienza","doi":"10.7417/CT.2025.5208","DOIUrl":"10.7417/CT.2025.5208","url":null,"abstract":"<p><strong>Introduction: </strong>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), developed in 2019, led to the outbreak of the COVID-19 pandemic state, which have significantly impacted on healthcare systems worldwide. During the pandemic state, in addition to all the problems related to high mortality and morbidity during the active phase of the disease, it had to deal with a condition known as \"Long-COVID\". Long-COVID includes both persistent symptomatic forms, where signs and symptoms last between 4 and 12 weeks, and post-COVID syndrome, where symptoms persist beyond 12 weeks. The evaluation system categorizes COVID-19 outcomes into four classes based on the degree of biological validity impairment: mild, moderate, moderate-severe, and severe. In the insurance field, this new \"entity\" led to difficulties related to damages compensation for infections developed in workplace, which has not completely been clarified nor today.</p><p><strong>Methods: </strong>The study was conducted on a sample of 3,127 health-care workers employed at the \"G. Martino\" University Hospital, in Messina. The percentage of individuals who contracted COVID-19 was analysed, evaluating how many were infected at workplace. Among those who contracted the virus at work, we further examined how many healthcare professionals were eligible for compensation under insurance frameworks related to Long- COVID.</p><p><strong>Results: </strong>The data analysis reveals that, out of the entire sample examined, 10 healthcare workers developed Long-COVID syndrome, with a severity classified as moderate (Biological Damage according to social insurance of healthcare workers: 1-15%). The lingering ef-fects included persistent asthenia, anosmia, stress-induced dyspnoea, outcomes of instrumentally documented pneumonia and myocarditis, as well as neuromuscular disorders. The collected data confirms that healthcare professionals had the highest percentage of COVID-19 infections (Fig. 1), with an infection rate of 23%, more than half of which occurred in the workplace.</p><p><strong>Discussion and conclusions: </strong>The definition of long-COVID is still quite complicated, as the ever-increasing number of symptoms that are attributable to this pathology, and the variability in the times of its onset, make its nosographic framework extremely difficult. In addition to the clinical-scientific difficulties arising from this condition, the impossibility of adequately classifying the pathology is associated with an equally complex management of the costs that the State must bear to restore the damage, as it usually happens in case of sequelae of infections contracted at workplace.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"213-218"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Diagnostic Biomarker of Preeclampsia: MicroRNAs in Maternal Blood Leukocytes in Preeclamptic Women Compared to Normal Pregnant Women.","authors":"S I Elshennawy, F G Yehia, H Elhakeem, L A Gad, A A Eldamanhory, A M Attia, I R Alsawy, A M I Ghit, M A Mohamed, A A Elboghdady, E G Rezk, M F I Mosa, M R Zohri, M A M El Kholy, W A Ayad, A A H Emam, M Y M Ahmed","doi":"10.7417/CT.2025.5216","DOIUrl":"10.7417/CT.2025.5216","url":null,"abstract":"<p><strong>Aim of the work.: </strong>The purpose of this study is to compare the expression levels of miR-21-3p and miR-155-5p in leukocytes from preeclampsia (PE) patients to healthy controls.</p><p><strong>Patients and methods: </strong>The miR-21-3p and miR-155-5p that have been linked to PE were our choices. In comparison to 50 healthy controls, the expression levels of miR-21-3p and miR-155-5p were examined in PE (n = 50). Quantitative PCR in real-time is used for this. Relative quantification values were produced by comparing the target miR's relative expression in the samples to that of the calibrator in the lab.</p><p><strong>Results: </strong>There was a significant decrease in the expression levels of miR-21-3p and miR-155-5p in PE group. The mean expression levels of miR-21-3p and miR-155-5p in PE were 1.12 ± 0.6 and 0.82 ±0.5, respectively compared to 1.52 ± 0.8 and 1.44 ± 0.9 in normal individuals.</p><p><strong>Conclusion: </strong>Our findings indicated that decreased miR-21-3p and miR-155-5p expression levels are associated with PE. A significant part of the pathophysiology of PE is played by miRNAs. Findings differentially expressed miRNAs in mother blood presents a chance to identify a simple-to-use PE biomarker.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"255-260"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short forms to assess Quality of Life Among elderly Women considering Stress Urinary Incontinence management with obesity co-morbidity.","authors":"A A Amr, F A Hesham, M A Ahmed, A E Yumna, A E Adel, A S Amany, A S Ahmed, A A Muhamed, S T S Wael, M S D Yasser, E M Bahaa Eldin, M T Elsayed, A A Mohamed, M A Walaa, R Rania, F E Ahmed, I M Mohamed, A Ahmed, H A A Alshaimaa, M A Attia, M E Fadila, H Yasmine, F S Ahmed","doi":"10.7417/CT.2025.5207","DOIUrl":"10.7417/CT.2025.5207","url":null,"abstract":"<p><strong>Aim: </strong>The intention is to make clear the detrimental clinical effects of obesity on older women's stress urine incontinence and quality of life.</p><p><strong>Patients and methods: </strong>This cross-sectional study included 150 women, 60 years of age or older, who were receiving treatment at the university hospitals in Alhussine, Alzahraa, Ain Shams, Assiut (Alazhar university), Damietta (Alazhar university),ZAGAZIG, HELWAN, Misr University for Science and Technology, Menoufia and Benha for urodynamic stress urine incontinence. Patients were categorised based on their body mass index (BMI), and appointments were made for the Incontinence Quality of Life Questionnaire and the Incontinence Severity Index.</p><p><strong>Results: </strong>The participants' mean ages were 64.1 ± 2.3 years for group I and 64.3 ± 2.1 years for group II, respectively. The mean (±SD) BMI in group I was 34.8 ± 3.4, whereas the mean (±SD) BMI in group II was 22.6 ± 2.4. There was no discernible difference between the two groups' mean gravidity or parity or prior delivery modes. In particular, obese women reported higher levels of symptom discomfort, had an increased incidence of incontinence episodes, and had a stronger impact on quality of life due to specific symptoms. Group II had a higher prevalence of mild symptoms, whereas group I had a higher prevalence of intermediate symptoms. Also, group I had a higher distribution of severe symptoms.</p><p><strong>Conclusion: </strong>Obesity reduces older women's quality of life ratings and influences the severity of urodynamic stress incontinence.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 2","pages":"207-212"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two cases of Sexual Activity-Related Deaths due to Vascular Dissection: investigating the Potential Link to phosphodiesterase type 5 inhibitor administration.","authors":"G Napoletano, B Treves, L De Paola, A Ghamlouch, F Del Duca, A De Matteis, L Di Mauro","doi":"10.7417/CT.2025.5191","DOIUrl":"https://doi.org/10.7417/CT.2025.5191","url":null,"abstract":"<p><strong>Abstract: </strong>Sexual activity-related sudden death (SArSD) is an uncommon phenomenon in forensic pathology, typically associated with preexisting vascular abnormalities that rupture due to sudden changes in blood pressure or heart rate during sexual activity. The current report presents two cases of SArSD in men with positive anamnesis for chronic sildenafil use. In Case 1, the cause of death was determined to be an intracranial hemorrhage that occurred shortly before sexual intercourse. In Case 2, death was attributed to the rupture of an abdominal aortic aneurysm, occurring during sexual activity and linked to substance abuse. While both deaths were attributed to SArSD, the potential role of sildenafil in promoting aneurysm formation or rupture remains a subject of debate. Intracerebral hemorrhages associated with sildenafil use appear to exhibit a consistent pattern, commonly affecting the basal nuclei, thalamus, and adjacent cerebral regions, particularly the lateral temporal lobe. Notably, in many cases descri-bed in literature sildenafil doses exceeding 50 mg were reported. The combined effects of sildenafil and substances (such as cocaine) in such events remain largely unexplored, underscoring the need for further research to elucidate their interaction. Cases of vascular dissections occurring independently of sexual activity suggest that sildenafil use warrants caution, particularly in individuals with underlying vascular vulnerabilities. Although rare clinical cases and autopsy findings have suggested a potential association between phosphodiesterase type 5 inhibitors (PDE5i) and hemorrhagic events, such as intracerebral hemorrhages or aneurysm ruptures, current evidence does not indicate that PDE5i have a significant or direct impact on blood pressure capable of causing the acute rupture of a healthy vessel. Nevertheless, further clinical and forensic studies are essential to elucidate the relationship between chronic or acute PDE5i use and hemorrhagic cerebrovascular accidents or aortic dissections.</p>","PeriodicalId":50686,"journal":{"name":"Clinica Terapeutica","volume":"176 Suppl 1(2)","pages":"70-76"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}